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Cardiac tamponade (CT) is a rare but potentially lethal complication associated with central venous catheters (CVCs). We present a 6-year-old boy who developed CT after CVC insertion in the right internal jugular vein, with its tip in the inferior vena cava. Initially, he was hospitalized to a tertiary hospital with presumptive diagnoses of pneumonia and left ankle cellulitis. Three days after CVC placement, he developed CT, manifesting as recurrent episodes of hypotension and bradycardia. Once a bedside echocardiography showed CT, pericardiocentesis was performed, resulting in successful resuscitation. Pericardiocentesis revealed a milk-appearing pericardial fluid, indicating chylopericardium. The boy also underwent debridement and joint irrigation of the left ankle, which turned out to be osteomyelitis. Although CVC tips in most reported CVC-related CTs have been commonly located in the right atrium, our case featured a tip located in the inferior vena cava. Additionally, chylopericardium was likely due to the extravasation of total parenteral nutrition fluid, rather than the usual causes, such as recent thoracic surgery. Understanding the mechanisms behind chylopericardium associated with CVCs and timely pericardiocentesis is crucial for improving the outcomes.

Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are potentially fatal complications in prematurely born infants. Extracorporeal membrane oxygenation (ECMO) may be a life-saving option for managing infants with BPD and PH. We present 2 patients who were successfully weaned off mechanical ventilators (MVs) through the application of ECMO. The patients were transferred to our institution after receiving MV care for 8 and 10 months, respectively, for BPD and PH. We were able to remove the patients from MVs after a period of ECMO-mediated lung rest. Although more research is required to determine specific criteria for ECMO use in patients with BPD and PH, our clinical experiences may contribute to the early application of ECMO in MV-dependent patients.

Background: Thyroid cancer is a slow-growing tumor with excellent oncological outcomes. However, few patients with unexpectedly severe outcomes are usually ignored. Current Concepts: Radioactive iodine therapy is the mainstay treatment for differentiated thyroid cancer with distant metastasis. The refractoriness to radioactive iodine therapy has been overcome by the emergence of targeted agents. First, multikinase inhibitors (sorafenib and lenvatinib) targeting the growth factor pathway were developed and approved as anticancer agents for patients with advanced differentiated thyroid cancer, regardless of their genetic features. With progress in sequencing techniques, the genetic backgrounds of tumors have unveiled new targets, including rearrangements during transformation and tropomyosin receptor kinase. Special attention should be paid to the national health insurance coverage of systemic therapeutics and genetic studies. Discussion and Conclusion: New drugs were introduced to treat previously untreatable advanced thyroid cancers. However, the cost of these drugs has increased with new developments, and only first-line drugs for thyroid cancer are still covered by insurance. These medical advances will remain an illusion for clinics and patients if improvements in healthcare policies do not accompany them. [ABSTRACT FROM AUTHOR]

Pleural metastasis is the most common cause of malignant diseases involving the pleura, and characterized by pleural effusion, nodules, and thickening. Pleuroparenchymal fibroelastosis (PPFE) is a disease characterized by apical pleural thickening and subjacent parenchymal fibrosis. We report a case of a 60-year-old male with lung cancer in the left lower lobe and underlying PPFE combined with left apical pleural metastasis. Initially, asymmetric left apical pleural thickening due to pleural metastasis was mistaken for PPFE. Additionally, we describe the imaging and histopathological findings of PPFE, including MRI findings. [ABSTRACT FROM AUTHOR]

Purpose: Health behavior is important for the treatment of tuberculosis patients. This study aims to clarify the concept of health behavior in tuberculosis patients. Methods: We used Rodger's evolutionary concept analysis method. A literature search was performed using the NDSL, NAL, RISS, PubMed, ProQuest, CINAHL, Web of Science and Cochrane Library published in Korean and English language from January 2015 to April 2021. After applying inclusion and exclusion criteria, a total of 69 articles were selected for final analysis. Results: The analysis showed that five attributes determine health behavior concepts: willpower, the choice for every moment, counterbalance, overcoming, and multi-level multi-causal processes. Conclusion: This study shows that health behavior in tuberculosis patients has evolved into a patient-centered approach in an evolutionary context. The results of this study will contribute to the development of intervention access and management programs for health care providers, including nurses. [ABSTRACT FROM AUTHOR]

Recent advance in low cost and light-weight drones has extended their application areas in both military and private sectors. Accordingly surveillance program against unfriendly drones has become an important issue. Drone detection and classification technique has long been emphasized in order to prevent attacks or accidents by commercial drones in urban areas. Most commercial drones have small sizes and low reflection and hence typical sensors that use acoustic, infrared, or radar signals exhibit limited performances. Recently, artificial intelligence algorithm has been actively exploited to enhance radar image identification performance. In this paper, we adopt machined learning algorithm for high resolution radar imaging in drone detection and classification applications. For this purpose, simulation is carried out against commercial drone models and compared with experimental data obtained through high resolution radar field test. [ABSTRACT FROM AUTHOR]

Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient's lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence. [ABSTRACT FROM AUTHOR]

Purpose: Agenesis of the septum pellucidum (ASP) is a very rare disease that can be isolated or associated with other brain abnormalities. The neurological prognosis of isolated ASP remains controversial. The aim of this study was to evaluate the clinical outcome of neonates with ASP. Methods: We retrospectively analyzed the medical records of 12 neonates with isolated ASP or ASP combined with other brain abnormalities who were born at Cheil General Hospital & Women's Healthcare Center between January 2007 and December 2017. Results: Of the 12 neonates, six were identified prenatally and six were identified postnatally. Isolated ASP was found in eight neonates; of these, four were detected antenatally. ASP associated with other brain abnormalities was found in four neonates. ASP was complete in nine neonates, including six with isolated ASP, and partial in three, including two with isolated ASP. Six of the eight neonates with isolated ASP had normal neurological development, except two who were lost to follow-up. Among the four neonates with other associated brain abnormalities, two had delayed motor development and a seizure, one had normal development, and one was lost to followup. In all neonates, ophthalmological examination revealed no optic nerve abnormalities. Conclusion: Isolated ASP seems to have a good neurological prognosis without ocular problems. This result needs to be confirmed by larger prospective studies over a longer developmental timeline. [ABSTRACT FROM AUTHOR]

Purpose: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. Methods: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into "symptomatic," "asymptomatic," and "asymptomatic with isolated abnormal automated auditory brainstem response (AABR)" groups. Clinical data were analyzed based on this classification. Results: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. Conclusion: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the outcomes and survival rates of very low birth weight infants (VLBWI) born over a 12-year period in a single center. Methods: A retrospective review of 613 VLBWI born from January 2000 to December 2011 was performed. We compared the incidence, survival rate, and morbidity of infants classified according to their birth weight or gestational age for the following periods: Period I (2000-2002), Period II (2003-2005), Period III (2006-2008), and Period IV (2009-2011). Results: The incidence of VLBWI was 0.7%, while the overall survival rate was 94.9%. The survival rates were 92.8%, 92.9%, 95.9%, and 97.5% for periods I, II, III and IV, respectively; the rates improved significantly over time (P<0.05). The average survival rate of extremely low birth weight infants was 85.9%, and it tended to increase over successive periods (P=0.06). The overall incidence of respiratory distress syndrome was 63.6%; patent ductus arteriosus; 43.6%; bronchopulmonary dysplasia, 30.5%; retinopathy of prematurity (≥grade III), 8.5%; sepsis, 6.5%; cystic periventricular leukomalacia, 3.8%; necrotizing enterocolitis (≥grade II), 3.4%; and intraventricular hemorrhage (≥grade III), 2.3%. A significant decrease was seen in some clinical parameters: the time to start feeding, duration of parenteral nutrition, and duration required to reach full enteral feeding in every successive three-year period (P<0.01). Conclusion: The overall survival rate of VLBWI born between January 2000 and December 2011 was 94.9%. This survival rate was found to increase significantly in each successive three-year period starting January 2000. [ABSTRACT FROM AUTHOR]

Purpose: Although the symptoms of benign transient non-organic ileus of neonate (BTNIN) are similar to that of Hirschsprung's disease (HD), the etiology underlying BTNIN remains unclear. In the present study, we aimed to compare laboratory and clinical characteristics of BTNIN with those of HD and to clarify the possibility of an association between food allergies and BTNIN. Methods: We retrospectively reviewed the data from 34 BTNIN and 11 HD patients from January 2005 to December 2011. We compared several variables between these patients, including sex, age, feeding method, rate (%) and absolute count of serum eosinophils, and eosinophil count in the rectal mucosa. Pearson chi-square tests and independent t-tests were used for statistical analysis. Results: BTNIN (N=34) is more likely to affect males as compared to HD (N=11), BTNIN had a longer duration of symptoms after birth, and BTNIN patients were more likely to be breast fed; all these factors were statistically significant (P=0.019, 0.000, and 0.000, respectively). The rate (%) and absolute count of serum eosinophils in the serum of BTNIN and HD patients was 3.9±2.4% and 401±388/HPF, respectively, and 1.4±0.8% and 170±110/HPF, respectively (P=0.001 and 0.000). Moreover, the eosinophil count in the rectal mucosa of BTNIN and HD patients was 14.4±12.9/ HPF and 5.2±4.7/HPF, respectively (P=0.017). Conclusion: We observed that BTNIN patients exhibited a later symptom onset, and that BTNIN was more closely associated with breast feeding as compared to HD. A greater number of eosinophils were present in the serum and rectal biopsies of BTNIN patients. Thus, we suggest that BTNIN is associated with food allergy. [ABSTRACT FROM AUTHOR]

Neonatal hypocalcemia is not uncommon, especially in premature neonates. It is usually treated by intravenous calcium gluconate administration. However, complications caused by the extravasation of intravenous calcium gluconate include calcinosis cutis, calcium deposition in the dermis, which is irritating to soft tissues and can produce tissue necrosis. We report a case of iatrogenic calcinosis cutis in a 27-dayold preterm baby following the extravasation of calcium gluconate. In this case, calcinosis cutis occurred along the venous pathway in a rare vascular calcification pattern but spontaneously resolved 2 months later. Although iatrogenic calcinosis cutis is generally benign, early recognition of the extravasation of calcium gluconate is important to avoid severe complications. This report aimed to provide a warning about the risks associated with intravenous calcium gluconate and information about the course of a rare presentation of the common disease calcinosis cutis with vascular calcification. [ABSTRACT FROM AUTHOR]

Purpose: Birthmarks are commonly observed during neonatal period and its prevalence varies between races and countries. Most skin lesions are transient and not require medical treatment. But some birthmarks have potential medical significance and may be the first sign of systemic medical problems. We carried out a prospective study to determine the prevalence of birthmarks in Korean newborn infants. Methods: From October 2012 to January 2013, 1,964 Korean newborn infants who were born in Cheil General Hospital, Kwandong University College of Medicine were evaluated for the presence of birthmarks within 48 hours after birth. Results: Among 1,964 newborn infants, 980 (49.9%) infants were male and 984 (50.1%) were female. The most common pigmentary birthmark was Mongolian spot (97.1%), which was mostly presented on sacrogluteal area, and was followed by nevocellular nevi (0.8%), café-au-lait spot (0.8%), and sebaceous nevi (0.2%). Among vascular birthmarks, the most common lesion was salmon patch (30.8%), and followed by port-wine stain (0.2%) and hemangioma (0.2%). The common other lesions were sebaceous hyperplasia (37.4%), erythema toxicum neonatorum (10.2%), milia (4.1%), skin appendage (2.6%), anal dimple (1.2%), auricular pit (0.9%), miliaria (0.5%), aplasia cutis congenita (0.2%) in the order of frequency. Conclusion: We studied the prevalence of the birthmarks in Korean newborn infants. The most common pigmentary birth mark was mongolian spot, and the most common vascular birthmark was salmon patch in Korean newborn infants. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe nurses' experiences of accidents in patient safety. Methods: Data were collected from October 8, 2011 to January 31, 2012 through in-depth interviews with seven nurses who had worked on wards or in the ICU in a university hospital. Data were analyzed by applying Colaizzi's phenomenological methodology. Results: The following six categories were extracted: Fear of the patient's condition caused by the accident, Conflict in the accident report, Blame on others and circumstances, Feeling guilty and sorry as the patient's condition is improving, Being disappointed with the unfavorable atmosphere in dealing with the accident, After the accident, being sensitive in performing nursing duties and being faithful to the principles. Conclusion: The results indicate that the organizational culture in the hospital related to accidents in patient safety is still closed and punitive, and such an atmosphere causes nurses to feel seriously hurt, but through this experience nurses are likely to mature as nursing professionals. Programs on prevention of accidents in patient safety and a system to guard against these accidents should be established. Also the organizational safety culture should be improved. [ABSTRACT FROM AUTHOR]

Hematoma resulting in acute respiratory distress associated with anterior cervical spine surgery is rare; however, it is a serious adverse complication and occurs primarily within postoperative three days and is cured in the hospital. Rarely, delayed hematoma occurs after discharge from the hospital, and treatment of respiration is difficult. In this review, we report on a case of acute respiratory distress due to delayed hematoma following anterior cervical discectomy and fusion, which occurred at postoperative five days [ABSTRACT FROM AUTHOR]

Purpose: Subaxial unilateral facet dislocation requires immediate reduction; however, cases of failure with reduction have also been reported. We analyzed the factors preventing closed traction reduction and attempted to determine the efficacy and indications of closed traction reduction. Materials and Methods: We selected 26 patients, 17 men and nine women. The average age of the patients in selected group was 49 years (20-69 years). Each patient was first treated with Gardner head traction and closed traction reduction. Each patient was checked for the degree of locking of the dislocated segment, intervertebral disc herniation, the degree of contralateral facet joint subluxation, and accompanied fracture. The effect of the location of the injured segment, age, and sex on closed reduction traction was analyzed. Results: A high rate of unsuccessful closed traction reduction was observed for patients with more than 50% locking of the dislocated facet joint (p=0.039). Intervertebral disc herniation, the degree of contralateral facet joint subluxation, facet joint fracture, and pedicle and lamina fracture were unrelated to the success of closed traction reduction. The location of dislocation and sex showed no statistically significant relevance to failure of closed traction reduction. A high rate of failure was observed for patients younger than 40 years. Of the 26 patients, closed traction reduction was successful for 12 and unsuccessful for 14. Conclusion: For patients whose degree of locking of the dislocated facet joint is less than 50%, closed traction reduction using skull traction is considered effective, however, for patients younger than 40 years or with more than 50% locking of the dislocated facet, prompt reduction under general anesthesia and subsequent appropriate surgery is considered beneficial. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the factors related to dyslipdemia and hypertension among male office workers. Methods: This study was a cross-sectional survey. The sample was 204 male office workers aged 30 to 62 years without cardiovascular disease and not taking medication for hypertension and dyslipidemia. Data were collected from November, 2011 to March, 2012. Dyslipidemia was examined by checking serum lipid profiles. Results: Dyslipidemia was related to career (adjusted OR 1.06, 95% CI 1.03~1.51), time spent at desk (adjusted OR 1.25, 95% CI 1.03~1.51), job stress of Q25-49 (adjusted OR 2.72, 95% CI 1.24~5.93), inactivity (adjusted OR 6.86, 95% CI 2.62~17.93), and snack intake frequency (adjusted OR 1.57, 95% CI 1.03~2.38). Hypertension was related to career (adjusted OR 1.07, 95% CI 1.01~1.14), heavy drinking (adjusted OR 5.00, 95% CI 1.25~20.04), and snack intake frequency (adjusted OR 2.10, 95% CI 1.33~3.34). Conclusion: Work and lifestyle-related factors were associated with dyslipidemia and hypertension in male office workers. These findings suggest that lifestyle intervention and improvement of working conditions are integral parts of cardiovascular disease prevention. [ABSTRACT FROM AUTHOR]

Thrombophlebitis occurs secondarily to inflammatory conditions of adjacent organs, and radiologic finding is essential for diagnosis. However, because of the rarity on clinical cases that involve the inferior mesenteric vein, many radiologists are unfamililiar with its location and appearance. We experience a case of septic thrombophlebitis with abscess complication sigmoid diverticulitis. CT scans reveals a low density thrombus and air in the inferior mesenteric vein, combining with perivascular fat infiltration, and focal wall defects with abscess formation. After surgical treatment, the abscess was not visible in the follow-up CT scans. Septic thrombophlebitis of the inferior mesenteric vein, although being a rare disease, should be diagnosed on CT according to the given unique location, the appearance of inflamed vein and the adjacent descending mesocolon. [ABSTRACT FROM AUTHOR]

Immunoglobulin (Ig) G4-related sclerosing disease is a recently described systemic fibro-inflammatory disease associated with an elevated circulating level of IgG4 and extensive IgG4-positive lymphoplasmacytic infiltration, resulting in sclerosing inflammation involving various body organs. We experienced one case where surgery confirmed IgG4-related sclerosing disease as a solitary lung mass mimicking lung cancer. We report radiologic findings including chest computed tomography and positron emission tomography computed tomography, with clinical manifestations of IgG4-related sclerosing disease. [ABSTRACT FROM AUTHOR]

A new poinsettia (Euphorbia pulcherrima Willd. Ex Klotzch) cv. 'Grace' was bred by the National Institute of Horticultural and Herbal Science (NIHHS) in 2009. A cross was made between 'PC-025' and 'Ichiban' in 2006. 'PC-025' is a line with curled peach color bracts, and 'Ichiban' is a cultivar with early coloring bright red bracts. 'Grace' was finally selected in 2009 after the investigation of the growth and flowering characteristics from 2007 to 2009. 'Grace' has peach colored elliptic bracts and weak intensity of rugosity between bract veins. The leaf blade of 'Grace' has ovate shape and dark green color. The petiole length of 'Grace' is medium, and stem color is greenish. 'Grace' has strong free-branching ability and short plant height. Bracts and transitional leaves of 'Grace' are fully colored 7 weeks after short-day commencement. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to examine the differences according to depressive symptom-related difficulty status. Methods 2828 participants were a divided into depressive symptom-related difficulty group (difficult group, n = 774), and a non-depressive symptom-related difficulty group (not difficult group, n = 2054). The psychological character of the participants were assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), Satisfaction with Life Scale (SWLS), the 12-item General Health Questionnaire (GHQ-12), and Conner-Davidson Resilience Scale (CD-RISC). Statistical analyses were done using t-test, chi-square, and analysis of covariance (ANCOVA). Results Compared with the no difficulty group, the difficulty group reported significantly higher score in all items of PHQ-9. The score of "feeling tired" was the highest and the score of "suicidal ideation" is the lowest in both groups. ANCOVA analysis that is adjusted with the total score of PHQ-9 showed the differences in SWLS, GHQ-12, and CD-RISC scores between the difficulty group and the no difficulty group. Conclusions The findings suggest that there are different characters on PHQ-9, SWLS, GHQ-12, and CD-RISC according to depressive symptom-related difficulty. Therefore, it is required not only to evaluate depressive symptoms in patients with depression, but also the depressive symptom-related difficulty to understand these differences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the effect of a medication self-management education program on medication awareness, communication with health care provider, medication misuse behavior, and blood pressure in elders with hypertension. Methods: The research design for this study was a non-equivalent control group quasi-experimental design. Participants were 23 elders for the control group, and 26 elders for the experimental group. The experimental group participated in the medication self-management education program which included the following, verbal education, 1:1 consultation, practice in medication self-management, and discussion over 5 sessions. Data were analyzed using the SPSS 18.0 program. Results: There were statistically significant differences between the experimental and control group for medication awareness, medication misuse behavior, and communication with health care providers. However, no significant difference was found between the two groups for blood pressure. Conclusion: The results indicate that the education program is effective in improving medication awareness and communication with health care providers and in decreasing medication misuse behavior. Therefore, it is recommended that this education program be used as an effective intervention for improving medication self-management for elders with hypertension. [ABSTRACT FROM AUTHOR]

Purpose: To quantify in vitro labeling efficiency of protamine sulfate (PS) and poly-L-lysine (PLL) for labeling of liuman mesencliymal stem cells (hMSCs) with superparamagnetic iron oxide (5PI0) using multi-eclio T2" magnetic resonance (MR) imaging at 4.7 T. Materials and Methods: Tine hMSCs were incubated with SPIO-PS or SPIO-PLL complexes. Their effects on the cell metabolism and differentiation capability were evaluated, respectively The decrease of iron concentrations in the labeled cells were assessed immediately, and at 4 d after labeling using multi-echo MR imaging at 4.71 The results were compared with those of Prussian blue colorimetry Results: The hMSCs were labeled more efficiently by SPIO-PLL than SPIO-PS without any significant effect on cell metabolism and differentiation capabilities. It was feasible to quantify the iron concentrations in SPIO-agarose-phantoms and in agarose mixture with the labeled cells from T2" maps obtained from multi-echo T2" MRI. However, the iron concentration of the labeled cells was significantly higher by T2"-maps than the results of Prussian blue colorimetry Conclusion: The hMSCs can be effectively labeled with SPIO-PLL complexes more than with SPIO-PS without significant change in cell metabolism and differentiation. In vitro quantification of the iron concentrations of the labeled is feasible from multi-echo T2" MRI, but needs further investigation. [ABSTRACT FROM AUTHOR]

Backgroud: Patients with type 2 diabetes are known to have an increased risk for osteoporotic fractures compared with non-diabetic subjects. We investigated whether the serum endogenous secretory receptor for advanced glycation end products (esRAGE) or pentosidine was associated with prevalent vertebral fractures in patients with type 2 diabetes. Methods: We enrolled 140 patients with type 2 diabetes mellitus (73 men aged 50 or older and 67 postmenopausal women). Lateral X-ray films of the spine revealed prevalent vertebral fractures. The serum concentration of esRAGE and pentosidine were measured. Results: The mean age of all patients was 66.2 ± 6.5 years and 22% of patients had prevalent vertebral fractures. Serum pentosidine levels were similar between those with and without vertebral fractures. There were no significant correlations between serum esRAGE levels and age, body mass index, duration of diabetes, and hemoglobin A1c. However, patients with moderate or severe vertebral fractures have a lower esRAGE level compared to those without after adjusting for age and gender (0.33 ± 0.12 ng/mL vs. 0.24 ± 0.03 ng/mL, P < 0.05). Logistic regression analysis demonstrated that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures (odds ratio, 16.6; 95% confidence interval, 1.4-198.5) than patients in the highest tertile. Conclusion: These results revealed that a low esRAGE level was independently associated with moderate or severe vertebral fractures in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

The right coronary artery arising from the left anterior descending artery is a rare coronary artery anomaly. In a 56-year-old female, an anomaly with the right coronary artery, originating from the left anterior descending artery, coursing anteriorly to the pulmonary artery was detected by cardiac CT. Therefore, we hereby report a case of the single left coronary artery diagnosed by a 64-slice multidetector cardiac CT. [ABSTRACT FROM AUTHOR]

This study aimed to explore the effect of translated writing on English writing performance of Korean learners of English and their perceptions on translated writing in comparison with direct writing depending on their English proficiency level. A total of 75 male high school students were divided into two groups according to their L2 writing expertise and were asked to perform two different writing tasks: 1) write directly in English (direct writing), and 2) write in Korean first and then translate the draft into English (translated writing). 136 written compositions (68 direct writing samples and 68 translated writing samples each) from 68 students were selected for analytical scoring and T-Unit analysis. The 68 students also filled a survey questionnaire which asked which type of writing was preferred for their English writing. The results showed that the performance of the direct writing was significantly better than that of the translated writing for high-level writers, while there were no great differences among low-level writers between the two writing tasks. T-Unit analysis revealed that syntactic complexity between direct and translated writings by two proficiency groups did not yield any statistically significant differences, and more students preferred translated writing to direct writing in general. Based on the results, pedagogical implications are suggested. [ABSTRACT FROM AUTHOR]

Background: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. Methods: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. Results: Of the 239 patients, mortality of 90 days was 43%, Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p 0.304), hospital size (p 0.260). and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p 0.026). Conclusions: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality. [ABSTRACT FROM AUTHOR]

Background: Atelectasis is a state of a collapsed and non-aerated region of the lung parenchyma, which is otherwise normal. This condition is usually associated with pulmonary disorders. The purpose of this study is to analyze the incidence and risk factors of atelectasis in patients admitted to the pediatric intensive care unit (PICU). Methods: We retrospectively analyzed the clinical characteristics and chest radiography of 280 PICU patients under 18 years old. We analyzed the incidence and pattern of atelectasis and compared the incidence according to the phase and mode of mechanical ventilation. We compared the incidence of ventilator care need and respiratory disease in 93 atelectasis patients. Results: Atelectasis incidence was 33.2%. The age (4.9 ± 4.4 years) was younger and the admission-duration (17.8 ± 25.1 days) was significantly longer in atelectasis patients (p < 0.01). Ventilator care neethand respiratory disease in atelectasis patients (86.0%, 66.7% respectively) was significantly higher than in non-atelectasis patients (62.6%, 43.3% respectively) (p < 0.01). Atelectasis incidence in ventilator-required patients and respiratory-diagnosed patients (40.6%, 43.4% respectively) was significantly higher than that in non ventilator-required patients and non respiratory-diagnosed patients (15.7%, 22.6% respectively) (p < 0.01). Atelectasis was more common in the right upper lobe (55.6%) and during or after ventilator care (62.6%) (p < 0.05). Atelectasis incidence in ventilator care did not differ between the assist-control and intermittent mandatory ventilation modes. Conclusions: In the PICU, atelectasis incidence was higher in patients with ventilator care and respiratory disease. Atelectasis was more common in the right upper lobe and in the phase after ventilator initiation. Atelectasis incidence in ventilator care did not differ between ventilation modes. [ABSTRACT FROM AUTHOR]

Objective: There have been several previous studies that the pathology of Alzheimer's disease (AD) might be in part caused or exacerbated by metals. But inconsistent results are often seen in evaluation of levels of metals in Alzheimer's disease patient's blood and control group. So, we conducted a systematic review using a comprehensive search strategy to find out whether there is significant difference between cognitive decline elderly people and normal control group. Method: Studies were searched in Pubmed, CINAHL and EMBASE with predefined words according to MeSH and purpose of this study. 996 studies were selected as primary screening, and two reviewers extracted relevant data independent of each other. 172 studies fulfilled the inclusion criteria. 32 studies about aluminum, copper, lead, mercury, cadmium finally selected. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. To synthesize the results of this study, summarized table was made. Results: In most studies, blood levels of mercury were high in cognitive decline group. But the majority study shows lead was not that different between cognitive decline group and control group. Measurements of other metal levels in whole blood, plasma, serum were inconsistent. However, there are not enough evidences to generalize with just number of studies since the studies have various degrees of validity. Conclusion: There is lack of evidences, till now, to use blood levels of metals as diagnostic purpose or predicting prognosis. Further studies which are supplemented limitations of previous studies are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit. METHODS: We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT. RESULTS: Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg.16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 ± 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 ± 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%). CONCLUSIONS: Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT. [ABSTRACT FROM AUTHOR]

This study aimed to investigate characteristics of English summary skills of Korean college freshmen. To achieve this aim, 120 English summary writings were collected from an English diagnostic test for college freshmen. Two texts with different features were used for the test. Text A is a persuasive essay with a problem/solution structure, and Text B is an expository essay with a collective structure. Fifty-three students summarized Text A and the others Text B. For each of the text groups, students were classified into two groups by their summary level. In the analysis of the writings considering the genre of the original text, organization, and adherence to summarization rules, it was found that the learners summarized the persuasive essay better than the expository essay. The high-ability group used various transition words and followed the structure of the original text when they organized their writings. As for summarization rules such as invention, selection, and paraphrasing, Text A group did not show any difference in their creation skill of topic sentence between the high- and low-ability group. On the other hand, the high-ability group that read Text B was better at creating general sentences than the low group. There was not a significant difference between the high- and low-ability groups in their paraphrasing skills, Text A group in general performing better than Text B group. Further suggestions and pedagogical implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to analyze the effect of growth hormone treatment (GHT) on craniofacial growth in children of short stature. Methods: Nineteen untreated children of short stature were referred from the Pediatric Department, Yeungnam University Hospital as a subject group. All subjects had lateral cephalograms taken before, after 1 year and after 2 years of growth hormone treatment. As a reference group, we selected 19 normal children with paired sampling who matched the subjects' age and sex, from the Department of Orthodontics, Kyungpook National University Hospital. Results: Before GHT, anterior cranial base length and upper posterior facial height, posterior total facial height, mandibular ramus length, and mandibular corpus length were significantly smaller in the reference group. In angular craniofacial measurements, saddle angle and mandibular plane angle were larger. SNA and SNB were smaller in the reference group. After two years of GHT, growth hormone accelerated growth in several craniofacial components. The posterior total facial height, the anterior, posterior cranial base length, and the mandibular ramus length were increased. And the difference in mandibular plane angle and ANB values compared with the reference group was decreased. Conclusions: GHT over 2 years leads to a craniofacial catch-up growth tendency, which is pronounced in interstitial cartilage and condylar cartilage. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to evaluate the effectiveness of an education program for patients with asthma who use inhalers. Methods: The research design for this study was a non-equivalent control group quasi-experimental study. Participants in this study were 36 patients for the control group, and 43 patients for the experimental group. The experimental group participated in the education program. The control group received the usual care. Data were collected before and 1 month and 2 months after the program finished and were analyzed using the SPSS 12.0 program. Results: The experimental group had significantly higher scores of knowledge of inhalers, and inhalation technique compared to the control group. However, no significant differences were found between two groups for PEFR, asthma instability, and satisfaction with inhalers. Conclusion: According to the results, the education program was effective in improving knowledge of inhalers, and inhalation technique. Therefore, it is recommended that this education program be used in clinical practice as an effective nursing intervention for patients with asthma on inhalers. [ABSTRACT FROM AUTHOR]

Using transcranial doppler ultrasonography (TCD) to measure the presence or absence of abnormalities in patent foramen ovale (PFO) is more effective than transesophageal echocardiography (TEE) because it is simple, inexpensive, and non-invasive. Thus, it can be a good alternative test in cases where it is difficult to perform TEE or in groups at a high risk of complications. Therefore, in this study, we sought to assist in arriving at a diagnosis by suggesting an appropriate method through the comparison of empirical results according to the presence or absence of blood use and varying patient posture. The results were compared depending on the patient’s posture and whether blood was used. Patients in whom both middle cerebral arteries were observed were targeted. In cases where the temporal window was defective, it was replaced with basilar artery and compared. There were higher positivity rate and accuracy for sitting position using valsalva maneuver (VM) than for Resting and supine position using VM. Therefore, if it is possible to perform a sitting position using VM with a mixture of blood, it would be a good idea to perform it.

Objectives The sodium index is an index that converts the estimated sodium intake calculated using a verified and reliable sodium estimation formula. This study aimed to determine the relationship between the sodium index and obesity indicators and the potential impact of excessive sodium consumption on obesity. Methods Obesity indicators, such as body mass index (BMI), body fat percentage, waist-to-hip ratio (WHR), and visceral fat levels, were analyzed in 120 university students (60 men and 60 women). The sodium index was calculated by indexing the estimated sodium intake according to age, sex, BMI, salt-eating habits, and salt-eating behaviors. The relationship between sodium index and obesity indicators was analyzed using multiple logistic regression. Results The estimated sodium intake was 3,907.1 mg, with 76.7% of the participants categorized under the “careful” level of sodium index and 10.8% under the “moderate” level. As the sodium index increased, the BMI, body fat percentage, WHR, and visceral fat levels significantly increased. All obesity indicators significantly increased in patients with a “severe” sodium index than in those with a “moderate” sodium index. In addition, a strong positive correlation was identified between obesity indicators and sodium index. When the “severe” sodium index was compared with the “moderate” sodium index, the risk of obesity based on body fat percentage increased by 2.181 times (95% confidence interval [CI], 1.526–3.118), while the risk of obesity based on visceral fat level increased by 4.073 times (95% CI, 2.097–7.911). Conclusions Our findings suggest a correlation between excessive sodium intake and obesity. Moreover, the sodium index can be used to determine sodium intake.

Pleural metastasis is the most common cause of malignant diseases involving the pleura, and characterized by pleural effusion, nodules, and thickening. Pleuroparenchymal fibroelastosis (PPFE) is a disease characterized by apical pleural thickening and subjacent parenchymal fibrosis. We report a case of a 60-year-old male with lung cancer in the left lower lobe and underlying PPFE combined with left apical pleural metastasis. Initially, asymmetric left apical pleural thickening due to pleural metastasis was mistaken for PPFE. Additionally, we describe the imaging and histopathological findings of PPFE, including MRI findings.

A pulmonary artery periadventitial hematoma is a rare complication of a Stanford type A intramural hematoma. As the proximal ascending aorta and pulmonary artery share a common adventitial layer, extravasated blood from the intramural hematoma in the ascending thoracic aorta may extend to beneath the adventitia of the pulmonary artery. The authors describe a case involving a 66-year-old male with acute chest pain who presented with a pulmonary artery periadventitial hematoma associated with a Stanford type A intramural hematoma.

Background: Numerous studies have examined the prevalence of Helicobacter pylori infection and clarithromycin (CLA) resistance rate of H. pylori. However, in South Korea, there is a lack of research analyzing specimens from local clinics and hospitals using molecular methods. This study aimed to assess the prevalence of H. pylori infection and CLA resistance across sex and age groups, as well as to explore regional variations in CLA resistance and its characteristics. Methods: Data from a laboratory information system from 2015 to 2018 were retrospectively analyzed to determine the prevalence of H. pylori infection and CLA resistance rate. The 23S ribosomal RNA genes of H. pylori were analyzed using a dual priming oligonucleotide-based multiplex polymerase chain reaction method. Results: The overall prevalence of H. pylori infection was 50.5%(12,000/23,773), with a significantly higher prevalence among males (53.5%) than females (47.0%). The CLA resistance rate was 28.3%, with a significantly higher rate among females (34.9%) than males (23.8%). Age group analysis revealed that the highest prevalence of H. pylori infection was among individuals in their 40s, whereas the highest CLA resistance rate was observed among those in their 60s. The CLA resistance rate exhibited an upward trend and varied among patients based on their place of residence, and A2143G mutation was the most prevalent across all regions. Conclusion: The prevalence of H. pylori infection and CLA resistance rate in Korea remain high and vary according to sex, age, and region. To effectively eradicate H. pylori, it is crucial to periodically monitor regional CLA resistance patterns and conduct CLA susceptibility testing before prescription.

The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing low-risk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.

The 2023 Korean Thyroid Association (KTA) Management Guideline for Patients with Thyroid Nodules constitute an update of the 2016 KTA guideline for thyroid nodules and cancers that focuses specifically on nodules. The 2023 guideline aim to offer updated guidance based on new evidence that reflects the changes in clinical practice since the 2016 KTA guideline. To update the 2023 guideline, a comprehensive literature search was conducted from January 2022 to May 2022. The literature search included studies, reviews, and other evidence involving human subjects that were published in English in MEDLINE (PubMed), Embase, and other relevant databases. Additional significant clinical trials and research studies published up to April 2023 were also reviewed. The limitations of the current evidence are discussed, and suggestions for areas in need of further research are identified. The purpose of this review is to provide a summary of the 2023 KTA guideline for the management of thyroid nodules released in May 2023 and to give a balanced insight with comparison of recent guidelines from other societies.

In response to the increase in the prevalence of chronic kidney disease (CKD) in Korea, the growth of patients requiring renal replacement therapy and the subsequent increase in medical costs, the rapid expansion of patients with end-stage kidney disease (ESKD), and the decrease in patients receiving home therapy, including peritoneal dialysis, the Korean Society of Nephrology has proclaimed the new policy, Kidney Health Plan 2033 (KHP 2033). KHP 2033 would serve as a milestone to bridge the current issues to a future solution by directing the prevention and progression of CKD and ESKD, particularly diabetic kidney disease, and increasing the proportion of home therapy, thereby reducing the socioeconomic burden of kidney disease and improving the quality of life. Here, we provide the background for the necessity of KHP 2033, as well as the contents of KHP 2033, and enlighten the Korean Society of Nephrology’s future goals. Together with patients, healthcare providers, academic societies, and national policymakers, we need to move forward with goal-oriented drive and leadership to achieve these goals.